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A Study on Vitamin D Level Among the Patients Attending in a Private Chamber in Dhaka City

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A Study on Vitamin D Level Among the Patients Attending in a Private Chamber in Dhaka City Original Article Northern International Medical College Journal A study on vitamin D level among the patients attending in a private chamber in Dhaka city MA Eva1, N Begum2, A S M A Kabir3, K W Ahmed4, M Sharmin5, S K Saha6, M B Bayazid7, S Hasan8 Abstract Background : Vitamin D deficiency is one of the most neglected public health issues all over the world. Near about 1 1 Dr. Moushumi Afrin Eva billion people round the world suffer from vitamin D deficiency. Most of the countries in Asia having high prevalence of Resident Medical Officer (RMO) vitamin D deficiency. Dept. of Internal Medicine Holy Family Medical College Objective : To find the vitamin D level among the patients attending in a private chamber in Dhaka city Dhaka A cross sectional observation study was carried out in a renowned diagnostic center of Dhaka city from 2 Methodology : Dr. Nasreen Begum July 2017 to June 2018. A sample of 1523 adult patients aged 18 years and above, presented with generalized body Assistant Professor aches and pains selected conveniently for the study. Blood samples were taken and serum vitamin D levels were Northern International Medical College, Dhaka measured. In this study, vitamin D concentration below10 ng/ml was considered as vitamin D deficiency, 20–30 ng/ml 3 as insufficiency, and 30–100 ng/ml as vitamin D sufficient. Data were analyzed by using SPSS version 22. Dr. A S M Anawrul Kabir Registrar, Dept. of Surgery Result : Out of 1523 patients 69.5% were women and 30.5% men. Urban and rural distribution was 63.16% and 4 Dr. Khondoker Wasee Ahmed 36.84% respectively. Among the participants vitamin D deficiency was 54%, 35.8% vitamin D insufficient, and only MO, Dept. of Internal Medicine 9.8% had normal level of vitamin D, regarding age specific deficiency highest 71.8% was in 71-80 years age group. Out Square Hospital Limited, Dhaka of 1058 female 39.5% were vitamin D deficient, 45.6% had insufficient vitamin D level. Only 14.9% female were found 5 Dr. Mahbuba Sharmin normal level. Age specific deficiency found highest 63.8% in 61-70 year age group. On the other hand out of 465 male Medical Officer participants, 24% were vitamin D deficient, 34% were insufficient and 42% had normal level vitamin D. Highest Bangabandhu Sheikh Mujib deficiency 42.5% found in age group 61-70years. Medical University, Dhaka 5 6 Considering the study result deficiency was higher among female than male. In female vitamin D deficiency Dr. Sumanta Kumar Saha Conclusion : Assistant Professor increased after age of 31year. Vitamin D deficiency found highest in old age and middle age group. Over all age specific Dept. of Medicine deficiency found significantly highest in 71 – 80 years. In both male and female Vitamin D deficiency was found highest 7 Dr. Md. Bodroddoza Bayazid above 61years of age. HMO, Dept of Medicine Dhaka Medical College, Dhaka DOI: https://doi.org/10.3329/nimcj.v10i2.45475 8 Shahriar Hasan (Physio Therapist) Northern International Medical College Journal Vol. 10 No. 2 January 2019, Page 393-396 Research Assistant BRAC James P Grant School of Introduction hydroxyvitamin D [25(OH)D], has been observed Public Health 1 BRAC University, Dhaka Vitamin D deficiency is a global public health in South Asian populations.. 3,6 concern, even in tropical regions where the risk It is our general belief that vitamin D deficiency Holy Family Medical College, of deficiency was previously assumed to be low is prevalent only in western countries, but actual Dhaka due to continuous vitamin D synthesis condition is reverse. It is surprising that in South stimulated by exposure to sun. Vitamin D is Asia, 80% of the apparently healthy population Correspondence essential for growth and development of the is deficient in vitamin D (<20 ng/ml) and up to Dr. Moushumi Afrin Eva body. It has been estimated that almost one Resident Medical Officer (RMO), 40% of the population is severely deficient Dept. of Internal Medicine, billion people in the world suffer from vitamin D (<9ng/ml). Sachan et al investigated Holy Family Medical College, Dhaka deficiency or insufficiency. Poor vitamin D status, hypovitaminosis D in Lucknow, India and found Email:[email protected] as indicated by low serum concentrations of 25- that 84% of pregnant women had 25(OH)D January 2019 n Volume 10 n Number 2 393 A study on vitamin D level among the patients attending in a private chamber in Dhaka city MA Eva et al. values below 22 ng/mL (the cut-off point in their research.2 years old who attended doctor’s chamber with back pain and Siddiqui and Rai found that in Northern Pakistan where sunlight generalized body ache. Written informed consent was taken was available in abundance, rickets was a common problem in during enrollment. This study was approved by the ethical infants and children.3 review committee of the concern diagnostic center. Privacy and anonymity of the participants were maintained. In under develop and developing countries,the major source of vitamin D for human is exposure to sunlight. Bangladesh is a Patients with a major medical illness such as hepatic tropical country of south Asia where sunlight is abundant almost dysfunction, metabolic disorders such as parathyroid, Diabetes year round. Therefore it seems that the prevalence of vitamin D Mellitus, significant thyroid dysfunction, renal diseases, any deficiency among the Bangladeshi is less. A study in northern others metabolic bone disorders, malignancies and patients who rural Bangladesh found about one-third of infants aged 1--6 were on steroid therapy or any anti-osteoporotic medications months were vitamin D-deficient.4 A study was carried out like hormone replacement therapy as bisphosphonates were among 18-33 years old Bangladeshi women reported low excluded. vitamin D levels in 81% women despite being exposed to sun Vitamin D analysis for more than 20 hours per week.5 The serum 25(OH)D is the most reliable marker of vitamin D Vitamin D has an important role in calcium homeostasis and status. Serum 25 (OH) D levels of all participants was measured bone health since its identification in 1921. Vitamin D deficiency and result recorded in data collection sheet. In this study, leads to bone diseases like rickets in children and osteomalacia vitamin D concentration below 10 ng/ml indicates vitamin D in women. Recently found connections between low vitamin D deficiency, whereas a concentration of 20–30 ng/ml is levels and a wide range of other illnesses such as diabetes, considered insufficient, and a 25(OH)D level of 30–100 ng/ml different type of cancers, autoimmune diseases, psychological indicate vitamin D sufficient. Data were analyzed by using SPSS disorders like depression, cardiovascular diseases, hypertension, version 22. lumbago, pre-eclampsia.6 Following surgery, injury and infection, inadequate vitamin D levels may lead to poor wound healing. Result Muscle weakness and muscle pain has long been associated A total of 1523 patients were included in the study. The age with vitamin D deficiency. Patient with vitamin D deficiency may ranged from 11-80 years. Out of 1523 patients 69.5% (n=1058) be misdiagnosed with fibromyalgia. degenerative joints disease were women and 30.5% (n=465) were men. Highest percent of arthritis, chronic fatigue syndrome and others disease.7 population (19.4%and 10.2%) were belonged to 31 to 40 years Vitamin D is a fat soluble steroid prohormone mainly produced and 41 to 50 years age group. 71.5% of the study population photochemically in the skin from 7 dehydrocholesterol. Vitamin belongs to 21-60 years of age group. About (63.16%) of our D consists of 2 bioequivalent forms. Vitamin D2, also known as study population was living in urban location and (36.84 %) ergocalciferol, is obtained from dietary vegetable sources and were living in rural area. Table – I oral supplements. Vitamin D3 (D3), also known as Table - I : Socio-demographic characters of study population cholecalciferol, is obtained primarily from skin exposure to Age group Number of Patients Percentage (%) ultraviolet B (UVB) radiation in sunlight, ingestion of food 11-20 217 14.3 % sources such as oily fish and fortified foods (milk, juices, margarines, yogurts, cereals, and soy), and oral supplements.8 21-30 266 17.4% Serum 25(OH)D is considered the best functional indicator of 31-40 296 19.4% vitamin D status reflecting the sum of cutaneous synthesis and 41-50 293 19.4% oral intake. Serum 25(OH) D level can be determined by direct 51-60 237 15.5% enzyme-linked immunosorbent assay. 61-70 118 7.7% Although it is a research issue all over the world, vitamin D 71-80 96 6.3% deficiency in Bangladesh yet has not been adequately investigated. Sex Methodology Male 465 30.5% Female 1058 69.5% This cross sectional observation study was carried out in a renowned diagnostic center of Dhaka from July 2017 to June Residence 2018. Following non probability convenient sampling technique Urban 962 63.16% 1523 patients were selected. Patients were between 11 to 80 Rural 561 36.84% January 2019 n Volume 10 n Number 2 394 Northern International Medical College Journal Out of the 1523 study subjects, 827(54%) were Vitamin D Table -V : Vitamin D status in male study population (n=465) deficient, 546(35.8%) were vitamin D insufficient, and only 150 Number of Vitamin D status (9.8%) patients had normal level of vitamin D. (Table II) Age group Patients Deficient n(%) Insufficient n(%) Sufficient n(%) 10-20 15(3.2%) 2(13.3%) 5(33.3%) 8(53.4%) Table: II : Vitamin D status among the study population(n=1523) 21-30 78(16.17) 16(20.5%) 21(26.9%) 41(52.6%) Vitamin D Vitamin D Frequency (n) Percent 31-40 49(10.5%) 9(18.1%) 11(22.7%) 29(59.2%) level (ng/ml) status (%) 41-50 84(18.0%) 18(21.4%) 39(46.4%) 27(32.2%) > 30 Normal 150 9.9% 51-60 96(20.6%) 14(14.5%) 26(27.0%) 56(58.5%) 20- 30 Insufficient 546 35.8% 61-70 112(24.0%) 48(42.3%) 36(32.7%) 28(25.0%) < 10 deficient 827 54.3% 71-80 31(6.6%) 5(16.1%) 20(64.6%) 6(19.3%) Highest percent of participants (71.9%) with vitamin D Total 465(100%) 112 (24%) 158(34%) 195(42%) deficiency was in 71-80 years age group.
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